Feeling sore after exercise? Here’s what science suggests helps (and what doesn’t)

Have you been hitting the gym again with COVID restrictions easing? Or getting back into running, cycling, or playing team sports?

As many of you might’ve experienced, the inevitable muscle soreness that comes after a break can be a tough barrier to overcome.

Here’s what causes this muscle soreness, and how best to manage it.

What is muscle soreness and why does it occur?

Some muscle soreness after a workout is normal. But it can be debilitating and deter you from further exercise. The scientific term used to describe these aches is delayed onset muscle soreness, or DOMS, which results from mechanical disruption of the muscle fibres, often called “microtears”.

This damage causes swelling and inflammation in the muscle fibres, and the release of substances that sensitise the nerves within the muscle, producing pain when the muscle contracts or is stretched.

This pain usually peaks 24-72 hours after exercise. The type of exercise that causes the most muscle soreness is “eccentric” exercise, which is where force is generated by the muscle as it lengthens—think about walking downhill or the lowering phase of a bicep curl.

There’s good news about this pain though. When the muscle cell recovers from this “microtrauma”, it gets stronger and can produce that force again without the same damage occurring. So although this strengthening process is initially painful, it’s essential for our body to adapt to our new training regime.

The inflammatory component of this process is necessary for the muscle tissue to strengthen and adapt, therefore the repeated use of anti-inflammatory medication to manage the associated pain could be detrimental to the training effect.

Will recovery gadgets put me out of my misery? Not necessarily

Before we even think about recovery from exercise, you first need to remember to start slow and progress gradually. The body adapts to physical load, so if this has been minimal during lockdown, your muscles, tendons and joints will need time to get used to resuming physical activity. And don’t forget to warm up by getting your heart rate up and the blood flowing to the muscles before every session, even if it’s a social game of touch footy!

Even if you do start slow, you may still suffer muscle soreness and you might want to know how to reduce it. There are heaps of new recovery gadgets and technologies these days that purport to help. But the jury is still out on some of these methods.

Some studies do show a benefit. There have been analyses and reviews on some of the more common recovery strategies including ice baths, massage, foam rollers and compression garments. These reviews tend to support their use as effective short-term post-exercise recovery strategies.

So, if you have the time or money—go for it! Make sure your ice baths are not too cold though, somewhere around 10-15℃ for ten minutes is probably about right.

And a word of caution on ice baths, don’t become too reliant on them in the long term, especially if you are a strength athlete. Emerging research has shown they may have a negative effect on your muscles, blunting some of the repair and rebuilding processes following resistance training.

But the efficacy of other recovery strategies remain unclear. Techniques like recovery boots or sleeves, float tanks and cryotherapy chambers are newer on the recovery scene. While there have been some promising findings, more studies are required before we can make an accurate judgement.

However, these recovery gadgets all seem to have one thing in common: they make you “feel” better. While the research doesn’t always show physical benefits for these techniques or gadgets, often using them will result in perceived lower levels of muscle soreness, pain and fatigue.

Is this just a placebo effect? Possibly, but the placebo effect is still a very powerful one—so if you believe a product will help you feel better, it probably will, on some level at least.

The ‘big rocks’ of recovery

Some of the above techniques could be classified as the “one-percenters” of recovery. But to properly recover, we need to focus on the “big rocks” of recovery. These include adequate sleep and optimal nutrition.

Sleep is one of the best recovery strategies we have, because this is when most of the muscle repair and recovery takes place. Ensuring a regular sleep routine and aiming for around eight hours of sleep per night is a good idea.

When it comes to nutrition, the exact strategy will vary from person to person and you should always seek out nutrition advice from a qualified professional, but remember the three R’s:

  • refuel (replacing carbohydrates after exercise)
  • rebuild (protein intake will aid in the muscle repair and rebuilding)
  • rehydrate (keep your fluid intake up, especially in these summer months!).

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Could COVID-19 immunity last decades? Here’s the science.

The body builds a protective fleet of immune cells when infected with COVID-19, and in many people, those defenses linger for more than six months after the infection clears, according to a new study.

The immune cells appear so stable, in fact, that immunity to the virus may last at least several years, the study authors said. “That amount of [immune] memory would likely prevent the vast majority of people from getting hospitalized disease, severe disease, for many years,” co-author Shane Crotty, a virologist at the La Jolla Institute of Immunology in California, told The New York Times, which first reported on the study.

That said, making predictions about how long immunity to the coronavirus lasts can be “tricky,” Nicolas Vabret, an assistant professor of medicine at the Mount Sinai Icahn School of Medicine, who was not involved in the study, told Live Science.

“It would be surprising to see the … immune cells build up in patients over six months and suddenly crash after one year,” Vabret said in an email. But “the only way to know whether SARS-CoV-2 immunity will last decades is to study the patients over the same period of time.” 

In other words, we won’t know exactly how long immunity lasts without continuing to study those who have recovered from COVID-19. However, the new study, posted Nov. 16 to the preprint database bioRxiv, does provide strong hints that the protection is long-lived — although clearly not in all people, as there have been several cases of individuals being reinfected with the coronavirus after recovering. 

The research dives into the ranks of the human immune system, assessing how different lines of defense change after a COVID-19 infection. 

These defenses include antibodies, which bind to the virus and either summon immune cells to destroy the bug or neutralize it themselves. Memory B cells, a kind of white blood cell, “remember” the virus after an infection clears and help quickly raise the body’s defenses, should the body be reexposed. Memory T cells, another kind of white blood cell, also learn to recognize the coronavirus and dispose of infected cells. Specifically, the authors looked at T cells called CD8+ and CD4+ cells.

The authors assessed all these immune cells and antibodies in 185 people who had recovered from COVID-19. A small number of participants never developed symptoms of the illness, but most experienced mild infections that did not require hospitalization. And 7% of the participants were hospitalized for severe disease. 

The majority of participants provided one blood sample, sometime between six days and eight months after the onset of their infections. Thirty-eight participants gave several blood samples between those time points, allowing the authors to track their immune response through time.

Ultimately, “one could argue that what they found is not so surprising, as the immune response dynamics they measure look like what you would expect from functioning immune systems,” Vabret said. 

The authors found that antibodies specific to the spike protein — a structure on the surface of the virus — remain stable for months and begin to wane about six to eight months after infection. At five months post-infection, nearly all the participants still carried antibodies. The volume of these antibodies differed widely between people, though, with an up to 200-fold difference between individuals. Antibody counts normally fall after an acute infection, Vabret noted, so the modest drop-off at six to eight months came as no surprise.

By comparison, memory T and B cells that recognize the virus appear extremely stable, the authors noted. “Essentially no decay of … memory B cells was observed between days 50 and 240,” or eight months later, Marc Jenkins, an immunologist at the University of Minnesota Medical School, who was not involved in the study, said in an email.

“Although some decay of memory T cells was observed, the decay was very slow and may flatten out at some point,” Jenkins added. There’s reason to believe that the number of memory T cells may stabilize sometime after infection, because T cells against a related coronavirus, SARS-CoV, have been found in recovered patients up to 17 years later, according to a study published July 15 in the journal Nature

Early in the pandemic, scientists raised concerns that immunity to the virus may wear off in about a year; this trend can be seen with the four coronaviruses that cause the common cold, Live Science previously reported. However, studies suggest that the body’s reaction to common coronaviruses may differ from that to viruses like SAR-CoV and SARS-CoV-2, which hopped from animals to humans. 

“We don’t really know why seasonal coronaviruses do not induce lasting protective immunity,” Vabret said. But the new study, along with other recent evidence, suggests that SARS-CoV-2 immunity may be more robust, said Jason Cyster, a professor of microbiology and immunology at the University of California, San Francisco, who was not involved in the study.

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That said, a few participants in the new study did not mount long-lasting immune responses to the novel virus. Their transient responses may come down to differences in how much virus they were initially exposed to, or genetics may explain the difference, Cyster said. For instance, genes known as human leukocyte antigen (HLA) genes differ widely between individuals and help alert the immune system to foreign invaders, Live Science previously reported

These inherent differences between people may help explain cases of COVID-19 reinfection, which have been relatively rare but are increasing in number, Science Magazine reported.

Again, to really understand how long COVID-19 immunity lasts, scientists need to continue to study recovered patients. “Certainly, we need to look six months down the road,” and see whether the T and B cell counts remain high, Cyster said.

Should immunity be long-term, one big question is whether that durability carries over to vaccines. But natural immunity and vaccine-generated immunity cannot be directly compared, Vabret noted. 

“The mechanisms by which vaccines induce immunity are not necessarily the same as the ones resulting from natural infection,” Vabret said. “So the immune protection resulting from a vaccine could last longer or shorter than the one resulting from natural infection.”

For example, the Pfizer and Moderna vaccines use a molecular messenger called mRNA to train the body to recognize and attack the coronavirus. No mRNA-based vaccine has ever been approved before, so “we practically know nothing about the durability of those responses,” Cyster said.

“I think [that’s] the big unknown for me, among the many,” he said.

But while some unanswered questions remain, the main takeaway from the new study is that “immune memory to SARS-CoV-2 is very stable,” Jenkins said. And — fingers crossed — perhaps those hopeful results will hold well into the future.

Originally published on Live Science. 

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Rural hospitals are under siege from COVID-19 – here’s what doctors are facing, in their own words

It’s difficult to put into words how hard COVID-19 is hitting rural America’s hospitals. North Dakota has so many cases, it’s allowing asymptomatic COVID-19-positive nurses to continue caring for patients to keep the hospitals staffed. Iowa and South Dakota have teetered on the edge of running out of hospital capacity.

Yet in many communities, the initial cooperation and goodwill seen early in the pandemic have given way to COVID-19 fatigue and anger, making it hard to implement and enforce public health measures, like wearing face masks, that can reduce the disease’s spread.

Rural health care systems entered the pandemic in already precarious financial positions. Over the years, shifting demographics, declining revenue and increasing operating expenses have made it harder for rural hospitals to stay in business. The pandemic has made it even more difficult. In mid-March, most rural hospitals halted elective procedures to slow the spread of the virus, cutting their revenue further, and many have faced price gouging for supplies given extreme shortages.

I work with rural doctors and hospital administrators across the country as a researcher, and I see the stress they’re under from the pandemic. Here is what two of them—Konnie Martin, chief executive officer at San Luis Valley Health in Alamosa, Colorado, and Dr. Jennifer Bacani McKenney, who practices family medicine in Fredonia, Kansas—are facing. Their experiences reflect what others are going through and how rural communities are innovating under extraordinary pressure.

I’ll let them explain in their own words.

Konnie Martin, Alamosa, Colorado

COVID-19 fatigue is real. It’s wearing on people. Everyone wishes we were past this. I read the other day about health care workers being the “keeper of fears.” During COVID-19, patients have disproportionately placed their fears on clinicians, many of whom experience the same fears themselves. I focus on building resilience, but it’s hard.

My hospital currently has seven patients with COVID-19 and can make room for as many as 12. Back in the spring, we converted a visiting specialist center into a temporary respiratory clinic to keep potentially infectious patients separate and reduce pressure on our emergency department.

It’s all about making sure we have enough staff and hospital capacity.

There isn’t any hospital that isn’t under siege, which means that getting patients to the right level of care can be a challenge. In the past few days, we have accepted three transfers from facilities that are on the front range. We’ve never had to do this before. With six ICU beds and 10 ventilators, we are trying to help others.

Influenza hasn’t arrived yet in our community, and I worry about when it comes. We have nearly 40 staff out right now on isolation or quarantine, a staggering number for a small facility. We are having to shift staffing coverage in half-day increments to keep up.

We are not at a point where we are even contemplating bringing COVID-19-positive staff back to work, like the governor of North Dakota suggested. I hope we never get there. We are, however, considering high-risk versus low-risk exposures. If a clinician is exposed to COVID-19 during an aerosolizing medical procedure, that’s high risk. If a clinician is exposed in a classroom of 50 people who were all socially distanced and wearing masks, that’s low risk. If we face critical workforce needs, we may bring back health care workers that have had low-risk exposures.

We have gained a lot of knowledge this year, and we all feel wiser now, but definitely older, too.

Dr. Jennifer Bacani McKenney, Fredonia, Kansas

We chose to live in a rural community because we look out for one another. Our one grocery store will deliver to your home. Our sheriff’s department will drive medications outside of city limits. If we could return to our rural values of caring for and protecting one another we would be in a better position. Somewhere along the way, these values took a back seat to politics and fear.

Wilson County, where I practice in Southeast Kansas, didn’t see its first COVID-19 case until April 15. By August, you could still count the number of cases on two hands. But by mid-November, the total was over 215 cases in a county with a population of about 8,500—meaning about one out of every 40 residents has been infected.

Our 25-bed critical-access hospital doesn’t have dedicated ICU beds, and it has only two ventilators. Emergency department calls are split among the five physicians in Fredonia. In addition to dealing with COVID-19 cases, we’re managing every other illness and injury that walks through the door, including strokes, heart attacks, traumatic injuries and rattlesnake bites.

We have sectioned off a hallway of rooms for suspected COVID-19 cases. Without an ICU, however, we have to rely on other hospitals. Recently, my partner had to transfer a patient who had a gastrointestinal bleed. She had to call 11 different hospitals to find one that could take the patient.

I feel lucky to have on-site testing in the hospital lab. But like many of my rural peers, getting enough face masks and other personal protective equipment early on was tough.

The community is tired, frustrated and stubborn. Politicians talk about relying on personal responsibility to end the pandemic, but I don’t see a majority of people wearing masks in public spaces despite pleas from health professionals. Some people are scared. Others act as if COVID-19 doesn’t exist.

Politics is making things harder. I have been Wilson County’s health officer for the past eight years. This year, county commissioners gained more control over COVID-19 health decisions.

When I proposed a mask mandate early in the pandemic, one county commissioner argued it would violate his rights. Another commissioner balked at one of my reports, saying I had no right to tell schools how to evaluate kids before they can return to sports, despite the health risks.

I recently proposed a new mask mandate given our rising numbers. I explained that masks would not only save lives, they would help businesses stay open and keep employees at work. The commissioners voted it down 3-0.

Preparing for the next pandemic

We live in an interconnected world where commerce and people cross state and national borders, and with that comes the risk of new diseases. America will face another pandemic in the future.

Rural health care delivery systems can leverage lessons from COVID-19 to prepare. Among other things, their emergency preparedness “tabletop exercises” can include planning for infectious disease outbreaks, in addition to fire and floods; mass casualty incidents; and chemical spills.

They can permanently diversify supply chain options from other industries, such as construction and agriculture, to help ensure access to needed supplies. To avoid staff and supply shortages, they can create regional rural health care networks for swapping staff, conducting testing and acquiring supplies.

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Here’s how much Kayleigh McEnany makes as White House press secretary

In April, former campaign aide and CNN contributor Kayleigh McEnany became President Donald Trump’s press secretary (via The New York Times). At that time, she replaced Stephanie Grisham, who returned to First Lady Melania Trump’s team as her chief of staff. Previously Sarah Huckabee Sanders and Sean Spicer claimed the role of press secretary under Trump (via Business Insider).

According to Fox Business, the salaries of every White House staffer, including the 31-year-old Florida native and Georgetown University grad, are disclosed every year. It’s interesting to note that McEnany, who interned for George Bush, is one of the highest paid staffers in the Trump White House, according to The U.S. Sun. It’s worth noting that per Fox Business, some staffers opt not to take a salary, namely Ivanka Trump and Jared Kushner.

So how much does the sometimes-controversial Trump supporter make for her role answering questions from the media? The answer may surprise some people.

The exact amount of money Kayleigh McEnany earns for her role as White House press secretary

Fox Business reports the Harvard Law School grad makes $183,000 per year as President Donald Trump’s mouthpiece to the press — although of course, he isn’t shy about voicing his own thoughts to the media. McEnany makes the same amount of money as economic adviser Larry Kudlow. When Kellyanne Conway served as senior counsel to Trump, she also earned the same salary as McEnany and Kudlow. Hope Hicks, who serves as an advisor to the President, also earns top dollar, as does Chief of Staff Mark Meadows and a number of other advisors.

Quite notably, McEnany, who married Tampa Bay Rays baseball player Sean Gilmartin in 2017 (his salary is $1 million according to Celebpie), makes more than half the salary of the Vice President, Mike Pence, who earns just over $231,000 for his role as second in command of the United States of America. Donald Trump’s presidential salary is $400,000, all of which is donated.

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The government has refused to drop the VAT on period pants – here's what to do

You may remember that a few months ago, we reported that period pant company Wuka was petitioning the government to drop the tax on sustainable menstrual products.

Wuka argued that women should be encouraged to use more sustainable means of managing periods, rather than being penalised for reducing waste.

While VAT is being dropped for tampons and pads from next year, eco products like period pants still have a 20% levy on them, which makes them economically unviable for many people.

So, Wuka urged the UK government to revise its pledge and make resuable period pants 0% VAT.

Unfortunately, HMRC has refused the request, citing that ‘difficulties in policing the scope of the relief create the potential for litigation, erosion of the tax base and a reduction in revenue’. However, it went onto say that period pants ‘may qualify for the zero rate when designed for children under the age of 14 yearsold providing they meet certain maximum sizing limits’.

‘This tax law codifies a body ideal that is exclusionary to any child over a slim waist size of Extra Small, sending out a message to any girl that doesn’t fit this definition that their body shape is not accepted as a child’s body and is excluded,’ explains Wuka’s CEO Ruby.

‘For parents of children above XS and under 14; this is excluding them from affordable menstrual products because of their child’s hip size.’

And that’s just the tip of the iceberg. What’s the significance of being 14? In England, Wales and Northern Ireland, someone is a minor if they’re under the age of 18 and a good number of girls don’t even start menstruating until they’re over 14 years old.

And in no part of HMRC’s response was there an acknowledgment of the waste created by tampons and periods.

Over the course of someone’s menstrual life, they can get through up to 15,000 pads and tampons – the vast number of which will end up in landfill as plastic waste. The applicators alone create a tonne of plastic waste, as activist Ella Daish highlighted this week when she created a 6ft tall Giant Tampax Applicator out of 1,200 Tampax applicators collected from beaches and waterways across the UK.

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Resistance training: here’s why it’s so effective for weight loss

Weight lifting, also known as resistance training, has been practised for centuries as a way of building muscular strength. Research shows that resistance training, whether done via body weight, resistance bands or machines, dumbbells or free weights, not only helps us build strength, but also improves muscle size and can help counteract age-related muscle loss.

More recently it’s become popular among those looking to lose weight. While exercises such as running and cycling are indeed effective for reducing body fat, these activities can simultaneously decrease muscle size, leading to weaker muscles and greater perceived weight loss, as muscle is more dense than fat. But unlike endurance exercises, evidence shows resistance training not only has beneficial effects on reducing body fat, it also increases muscle size and strength.

The ‘after-burn effect’

When we exercise, our muscles need more energy than they do when resting. This energy comes from our muscles’ ability to break down fat and carbohydrate (stored within the muscle, liver and fat tissue) with the help of oxygen. So during exercise, we breathe faster and our heart works harder to pump more oxygen, fat, and carbohydrate to our exercising muscles.

What is less obvious, however, is that after we’ve finished exercising, oxygen uptake actually remains elevated in order to restore muscles to their resting state by breaking down stored fat and carbohydrates. This phenomenon is called excess post-exercise oxygen consumption (EPOC) – though more commonly known as the “after-burn effect”. It describes how long oxygen uptake remains elevated after exercise in order to help the muscles recover.

The extent and duration of the after-burn effect is determined by the type, length, and intensity of exercise, as well as fitness level and diet. Longer-lasting exercise that uses multiple large muscles, performed to or near fatigue, results in higher and longer-lasting after-burn.

High-intensity interval training (HIIT) and high intensity resistance training are most effective at elevating both short and long-term after-burn. The reason HIIT-type exercises are thought to be more effective than steady-state endurance exercise is because of the increased fatigue associated with HIIT. This fatigue leads to more oxygen and energy required over a prolonged period to repair damaged muscle and replenish depleted energy stores. As such, resistance exercise is an effective way to lose excess fat due to the high calorie cost of the actual training session, and the “after-burn effect”.

Long-term fat loss

Resistance training can also be effective for long-term weight control, too. This is because muscle size plays a major role in determining resting metabolic rate (RMR), which is how many calories your body requires to function at rest. Resting metabolic rate accounts for 60-75% of total energy expenditure in non-exercising people, and fat is the body’s preferred energy source at rest.

Increasing muscle size through resistance training increases RMR, thereby increasing or sustaining fat loss over time. A review of 18 studies found that resistance training was effective at increasing resting metabolic rate, whereas aerobic exercise and combined aerobic and resistance exercise were not as effective. However, it’s also important to control calorie intake in order to lose fat and sustain fat loss.

Resistance training exercises should engage the largest muscle groups, use whole body exercises performed standing and should involve two or more joints. All of these make the body work harder, thereby increasing the amount of muscle and therefore RMR. An effective resistance training programme should combine intensity, volume (number of exercises and sets), and progression (increasing both as you get stronger). The intensity should be high enough that you feel challenged during your workout.

The most effective way of doing this is using the repetition maximum method. For the purpose of fat loss, this should be performing between six and ten repetitions of an exercise with a resistance that results in fatigue, so that you cannot comfortably do another full repetition after the last one. Three to four sets, two or three times a week for each muscle group is recommended.

The repetition maximum method also ensures progression, because the stronger you get, the more you will need to increase resistance or load to cause fatigue by the tenth repetition. Progression can be achieved by increasing the resistance or intensity so that fatigue occurs after performing fewer repetitions, say eight or six.

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Your Lifestyle Choices Are Causing Great Damage to Your Health- Here’s How You Can Ward Off Autoimmune Diseases

Doing what’s convenient has become almost second nature to us. Whether it’s staying back at work, giving up on sleep to complete pending tasks, or opting for a quick and easy-to-eat meal, we constantly make choices that are bad for us. We’ve become our own worst enemies! And, the numbers are there to prove it. In the last three decades, the rate of autoimmune disorders has increased drastically.

Granted autoimmunity is commonly passed down through genetics but, recent research into the field suggests that our environment and life choices are doing greater harm to us.

While it’s true that in today’s day and age, we can’t escape from our sleep-deprived and stressed-out lifestyles but, we can rest assured that switching to better dietary habits will significantly decrease our chances of getting autoimmune diseases, and it will substantially improve the quality of our lives.

How Our Immune System Works

In many ways, our immune system functions similarly to a home security system. Both systems are designed in a manner that ensures intruders are locked outside, while we remain safely inside.

Unlike a security system, however, when our immune system notices any threats in the form of bacteria, parasites, viruses, or any other harmful substances from the outer environment, it instantly activates its inflammatory pathways to ensure their destruction.

However, sometimes our body loses its ability to differentiate between substances that belong inside and outside it. In such cases, it launches inflammatory pathways in a state of “self-attack”. This is what is happening inside our bodies when we have autoimmunity. Basically, it’s like having the home security go off for no reason, rendering us unable to stay inside our home.

Causes of Misdiagnosis

During autoimmunity, it is common for different organs to be attacked. Hence, each of its types is classified according to the organ being affected. Common types of autoimmunity include type 1 diabetes, irritable bowel disease, rheumatoid arthritis, multiple sclerosis, Hashimoto’s disease, celiac disease, and Grave’s disease.

Depending on the symptoms that occur, doctors order a biopsy, blood tests, or imaging. Autoimmunity, however, can be gravely complex, and doctors are known to have a hard time coming to a conclusion while dealing with it.

How To Stay Immune

Since studies have proven that the environment can have adverse effects on us, we have to ensure that we limit the multiple stressors present within our lifestyle choices. Yes, this means changing everything, down to the last scratch.

No more overtime, no more sleepless nights, no more unhealthy dietary choices. Remember that autoimmunity is genetic, and we always run the risk of passing it on to the next generation. Switching up our lifestyle for the sake of our health will only cause our bodies to bless us like never before.

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Here's When a Sore Throat Might Be a Symptom of the Coronavirus

Since news of COVID-19, which was first detected in December 2019 in Wuhan, China, exploded onto the scene, there has been one thing that remains constant: Each day we learn more and more about the virus.

That includes its potential symptoms, which often seem run-of-the-mill. Take a sore throat—you might be tempted to shrug off this symptom, but even as one of the less commonly known ones (the most prevalent are fever, dry cough, tiredness, and shortness of breath), it may still indicate infection.

In fact, the World Health Organization notes that 13.9 percent of COVID-19 patients have presented with sore throats.

“Some patients that have experienced sore throat during COVID-19 have reported that it feels like a super dry throat,” says Leo Nissola, M.D., a scientist and investigator at the COVID-19 National Convalescence Plasma Project as well as advisor at COVIDActNow. “And the medical reports show redness in the throat, without bacterial infection, like strep, for example.”

Is a Sore Throat a Symptom of COVID-19?

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That’s a tricky question.

There are numerous causes for inflammation of the inner lining of the throat, including allergies, upper respiratory infections (both viral and bacterial), acid reflux, and even throat cancer.

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Not to mention this: “There is still so much we don’t know about COVID-19 and what we do know has been evolving over time,” says Inna Husain, M.D., an assistant professor in otolaryngology at Rush University Medical Center in Chicago.

“At this time, all upper respiratory illnesses are COVID-19 until proven otherwise.” What’s more, an April review in the European Archives of Oto-Rhino-Laryngology revealed that ear, nose, and throat symptoms may precede the development of severe cases of COVID-19.

That said, “there is nothing intrinsically different between a sore throat brought on by COVID-19 and one brought on by any other upper respiratory infections,” says Michael Lerner, M.D., a Yale Medicine laryngologist and assistant professor of otolaryngology at Yale School of Medicine.

What, Exactly, Does a “Sore Throat” Mean?

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On a basic level, you will experience some sort of discomfort in your throat. More specifically, you’ll feel pain when swallowing that can be achy, sharp, or even create a burning sensation.

A sore throat may also be accompanied by a runny nose, nasal congestion, cough, or fever. Other symptoms, according to Alexandra Kreps, M.D., an internist at Tru Whole Care, include “changes in your voice, swollen lymph nodes in your neck or jaw area, and when looking at your tonsils in a mirror they may be red and irritated or could have white patches or pus if severely infected.”

However, Dr. Nissola, says “it is more likely to be a COVID-related sore throat if there are more symptoms, such as fever and malaise.”

A good rule of thumb: “If your sore throat is also accompanied with fever or cough, be suspicious. If your sore throat comes after an episode of heartburn likely its related to reflux. If it is accompanied by sino-nasal congestion, runny nose, and sneezing, it may be allergies,” says Dr. Husain.

What Should You Do If You Have a Sore Throat?

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How you treat your sore throat symptoms should really consider the root cause.

Generally, though, Dr. Husain recommends hydration (drinking water or tea), steam inhalation, and lozenges containing lubricants such as honey. Pain relievers such as Tylenol can also help with discomfort.

Adds Dr. Lerner: If sore throat is from excessive coughing, you can address it though cough suppressants. For nasal congestion, which causes mouth breathing and dryness, try humidification or hydration through nasal saline or irrigation. “Patients that have COVID-19, should be cautious of nasal spread and do this in a safe way, so as not to expose others to aerosols and droplets that may occur from these types of treatments,” he says.

If sore throat is due to allergies, on the other hand, pretreatment with antihistamine prior to allergy season or known allergen exposure— in other wards take an allergy pill— can be helpful, says Dr. Husain.

Last, if the sore throat is caused by reflux, following an anti-reflux diet may lead to a favorable outcome. “I would encourage people to eliminate anything heavily acidic or citrus as this can irritate the lining of the throat. Hard foods such as crackers or chips can also be irritating,” says Dr. Husain, who notes that if a sore throat is present, avoiding coffee or alcohol as well as reducing smoking cigarettes, smoking marijuana, and avoiding vaping is recommended.

While none of these things will necessarily “cure” a sore throat, they can help with some of the discomfort associated with it.

Should You Get Tested for COVID-19 if You Have a Sore Throat?

“For people with nuisance, acute onset symptoms, or any other listed by the Centers for Disease Control as potentially a symptom for COVID, it is important to talk to your healthcare provider to help determine if testing is appropriate,” says Dr. Learner.

Overall, to help keep COVID-19 or any infection or illness at bay, wash your hands frequently, wear a mask and engage in social-distancing.

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Here's What It Really Means When a Narcissist Says 'I'm Sorry'

Clinical psychologist and therapist Dr. Ramani Durvasula makes videos educating people about how to best spot harmful toxic behavior in others, and what to do to protect yourself and limit the damage that can be wrought when you have a narcissist in your life. Having previously explained why it’s not wise to call out a narcissist, Durvasula’s most recent post explores how to respond if a narcissist actually apologizes for the way they have acted.

“The idea that their apology means they understand what they did, and they’re going to change their behavior, it isn’t true,” she says, “and if you hold that belief, it’s likely that you’re going to be very disappointed.”

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“An apology, done correctly, is taking responsibility; addressing the other person’s feelings, striving for reconciliation, and committing to learning from it,” she continues. “Unfortunately, that’s not what a narcissistic apology is. A narcissistic apology is sort of a way of keeping the trains running on time, of getting off the hook for something, of getting back to the way they want things to be.”

A narcissist doesn’t actually care that they hurt somebody else, and often, Durvasula points out, an apology only comes after a lengthy argument where they believe the person they hurt may take away their “supply.” And in each instance, the narcissist does not learn from the experience or adapt their behavior, and the cycle continues.

It’s pretty easy to identify a narcissist’s apology, simply because they won’t take responsibility for what they did. We’ve all heard that particular kind of non-apology, when somebody sounds like they’re apologizing but really they’re talking around their own accountability by saying things like “I’m sorry you feel that way.”

“In all of these apologies, what you see is that they are not apologizing for something they did or said,” says Durvasula. “They are in essence, though, using the apology as a way of gaslighting you and invalidating your experience: ‘I’m sorry you feel that way,’ meaning ‘you probably shouldn’t.'”

A healthy apology, Durvasula explains, involves acknowledging and owning the original action, not just the reaction. There’s a huge difference between saying “I’m sorry you’re hurt” and “I’m sorry I hurt you, I’ll try to do better.” Durvasula’s three hallmarks of a healthy apology are responsibility, acknowledgment, and commitment.

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We may be able to eliminate coronavirus, but we’ll probably never eradicate it. Here’s the difference

Compared to many other countries around the world, Australia and New Zealand have done an exceptional job controlling COVID-19.

As of May 7, there were 794 active cases of COVID-19 in Australia. Only 62 were in hospital.

The situation in New Zealand is similar, with 136 active cases, only two of whom are in hospital.

If we continue on this path, could we eliminate COVID-19 from Australia and New Zealand?

Control –> elimination –> eradication

In order to answer this question, we first to need to understand what elimination means in the context of disease, and how it differs from control and eradication.

Disease control is when we see a reduction in disease incidence and prevalence (new cases and current cases) as a result of public health measures. The reduction does not mean to zero cases, but rather to an acceptable level.

Unfortunately, there’s no consensus on what is acceptable. It can differ from disease to disease and from jurisdiction to jurisdiction.

As an example, there were only 81 cases of measles reported in Australia in 2017. Measles is considered under control in Australia.

Conversely, measles is not regarded as controlled in New Zealand, where there was an outbreak in 2019. From January 1, 2019, to February 21, 2020, New Zealand recorded 2,194 measles cases.

For disease elimination, there must be zero new cases of the disease in a defined geographic area. There is no defined time period this needs to be sustained for—it usually depends on the incubation period of the disease (the time between being exposed to the virus and the onset of symptoms).

For example, the South Australian government is looking for 28 days of no new coronavirus cases (twice the incubation period of COVID-19) before they will consider it eliminated.

Even when a disease has been eliminated, we continue intervention measures such as border controls and surveillance testing to ensure it doesn’t come back.

For example, in Australia, we have successfully eliminated rubella (German measles). But we maintain an immunization schedule and disease surveillance program.

Finally, disease eradication is when there is zero incidence worldwide of a disease following deliberate efforts to get rid of it. In this scenario, we no longer need intervention measures.

Only two infectious diseases have been declared eradicated by the World Health Organisation – smallpox in 1980 and rinderpest (a disease in cattle caused by the paramyxovirus) in 2011.

Polio is close to eradication with only 539 cases reported worldwide in 2019.

Guinea worm disease is also close with a total of just 19 human cases from January to June 2019 across two African countries.

What stage are we at with COVID-19?

In Australia and New Zealand we currently have COVID-19 under control.

Importantly, in Australia, the effective reproduction number (Reff) is close to zero. Estimates of Reff come from mathematical modelling, which has not been published for New Zealand, but the Reff is likely to be close to zero in New Zealand too.

The Reff is the average number of people each infected person infects. So a Reff of 2 means on average, each person with COVID-19 infects two others.

If the Reff is greater than 1 the epidemic continues; if the Reff is equal to 1 it becomes endemic (that is, it grumbles along on a permanent basis); and if the Reff is lower than 1, the epidemic dies out.

So we could be on the way to elimination.

In both Australia and New Zealand we have found almost all of the imported cases, quarantined them, and undertaken contact tracing. Based on extensive community testing, there also appear to be very few community-acquired cases.

The next step in both countries will be sentinel surveillance, where random testing is carried out in selected groups. Hopefully in time these results will be able to show us COVID-19 has been eliminated.

It’s unlikely COVID-19 will ever be eradicated

To be eradicated, a disease needs to be both preventable and treatable. At the moment, we neither have anything to prevent COVID-19 (such as a vaccine) nor any proven treatments (such as antivirals).

Even if a vaccine does become available, SARS-CoV-2 (the virus that causes COVID-19) easily mutates. So we would be in a situation like we are with influenza, where we need annual vaccinations targeting the circulating strains.

The other factor making COVID-19 very difficult if not impossible to eradicate is the fact many infected people have few or no symptoms, and people could still be infectious even with no symptoms. This makes case detection very difficult.

At least with smallpox, it was easy to see whether someone was infected, as their body was covered in pustules (fluid-containing swellings).

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